The present invention relates to a method of using a retractor device for the surgical repair of shallow body sites, such as inguinal, femoral, and incisional hernias., requiring a special stable retractor which is firmly, but removably fastened to the shallow surrounding tissues of the shallow incision.
Other shallow surgeries for which the present invention is applicable include neck surgeries, wherein shallow tissues such as the platysma muscles and sternocleidomastoid muscles must be held apart. The present invention may also be used in vascular surgeries, such as femoral bypass surgeries, laminectomies, wherein shallow erector-spinae muscles must be retracted, abdominal wall surgeries, thyroid surgeries and skin melanoma excisions.
The retractor includes an adjustable four sided frame with opposing pairs of frame members, each pair having different but cooperative holding elements. One pair of holding elements is for holding open the opposing skin corners of the incision from encroachments by fatty tissues, and the other pair of holding elements is for spreading open the incision and maintaining the fitting of the retractor in place at the incisional site without slippage or shifting. The former includes a pair of holding elements with two extension members with rounded corner blades for wrapping around and gently holding the skin corners apart.
The latter includes another pair of further holding elements, each further holding element including a plurality of pointed tip hooks for anchoring the retractor in place at the incisional site.
Each of the holding elements may be alternately attached to extension members which each have a slot axially extending for a portion of the length of the extension member to vary the distance of the respective holding elements from each other. The movement of one of the holding elements and extension members toward or away from another of the respective other holding elements and extension members thereto is accomplished by the axial movement of a wing nut within the axial slot, within the extension member of each holding element.
To insure stability of the present invention at a shallow surgical site, there is provided a four sided frame with two pairs of opposing generally linear frame elements, including a pair of generally linear parallel main bars, each main bar having two ends, and the pair of generally linear main bars connected at each end to respective ends of a pair of opposing generally linear strut bars holding the rounded corner blade holding elements. The generally linear main bars each have extending generally perpendicular therefrom the aforementioned plurality of pointed tip hooks f or anchoring the retractor in place at the incisional site.
Because hernia surgery requires shallow incisions, it is important that the retractor be held in place without slippage or shifting during the surgery. Unlike deep incision conventional retractors, which have deep scoops for reaching down within the body to anchor the retractor in place around organs, tissue and fascia deep within the body, the hernia surgery incision is quite shallow, with very little tissue for anchoring the retractor in place. Therefore, the present retractor includes the aforementioned opposing pairs of pointed tip hooks which extend generally downward vertically, perpendicular to the plane of the ma]or axis of the main bars of the retractor for a short distance, to limit the vertical distance of the frame from the anchored incisional site, so that the center of gravity of the retractor frame is close to the tissue walls against which the pointed tip hooks contact. These pointed tip hooks curve inward toward the incised walls, so that the hooks can contact and engage the shallow hernia incisional tissues and anchor the retractor in place at the surgical incision without slippage or shifting.
Shallow hernia surgeries are discussed in general in scholarly scientific texts, such as Welsh,"Inguinal hernia repair: a contemporary approach to a common procedure," MODERN MEDICINE, Apr. 1, 1974, pp. 49-54, New York Times Media Company, Inc.; Blakemore, "Should ice repair for inguinal hernia," SURGERY, Aug. 1969, Vol. 66, No. 2, pp. 450-459; Wantz, "The Canadian Repair of Inguinal Hernia," HERNIA, Third Edition, Chapter 12, ed. Nyhus, J. B. Lippincott Company, pp 236-248; and Skandalakis et al, "The Surgical Anatomy of the Inguinal Area - Part I, CONTEMPORARY SURGERY, Vol. 38, Jan. 1991, pp. 20-37.
The unpatented prior art includes the Applicant's use of a Vietlander retractor tool, which surgical tool traditionally includes two handles movable about a common hinge, such that manual exertion of force in the scissors-type handles causes opposite teeth-like end portions to hold opposite sites of an incision open during surgery. However, the repeated use of a Vietlander retractor demonstrated that other retractors and assistants were necessary simultaneously, such as a Richardson retractor or a hernia hook, which retractors may be subject to slippage from a desired position at the surgical site.
Subsequent use of a Vietlander retractor in combination with a rounded bladder blade failed to make the incisional site any more stable to any significant decree.
Moreover, the repeated use of a three sided U-shaped Balfour type frame, failed to stabilize the incisional site either. In the Balfour U-shaped frame, there is provided a pair of opposing, parallel frame elements, connected at one end by a third, perpendicular frame member. The two opposing frame members of the Balfour three sided frame each have extending perpendicularly downward further U-shaped retracting elements with rounded edges. These further U-shaped elements may stabilize deep, non-shallow surgical sites, such as abdominal surgeries, because the further U-shaped elements can anchor the prior art retractor in place by pressing against deep organs and tissues.
However, the use of such a Balfour type frame, with a rounded bladder blade extending from the third, perpendicular frame element, failed to significantly stabilize this prior art retractor in place, resulting in loosening of the retractor from shallow surgical sites without other -manual restricting measures.
Prior surgical retractor patents do not achieve the stability of the present invention, which prior art patents include U.S. Pat. No. 1,400,616 of McCrory and Person, as well as U.S. Pat. No. 2,564,118 of Mahorner, which both describe the use of teeth-like retractors on frames. U.S. Pat. Nos. 3,168,093 of Gauthier, 3,965,890 also of Gauthier, and 4,344,420 of Forder are examples of patents that disclose the use of rounded elements mounted on frames. Other U.S. Pat. Nos., such as Strauss, Pat. No. 1,747,799, Crossley, Pat. No. 1,375,445, Thompson, Pat. No. 3,221,743 and Jensen, Pat. No. 3,572,326, relate to adjustable frames and retractor elements.
U.S. Pat. No. 5,052,374 of Alvarez-Jacinto discloses a hernia retractor in an elliptical frame for shallow hernia surgeries. However, the Alvarez-jacinto device uses spring-loaded "clothes pin" types of holders to pinch and grip incised tissues, utilizing complicated mechanisms which may possibly cause ischemia and interfere with blood-flow within the squeezed portions of the incised tissues. In addition, since each pincer tool of Alvarez-Jacinto must be individually applied, the retractor may slip during installation.
While the Mahorner device has teeth-like retractors, and the Gauthier devices show scoop-like retractor blades, none of these prior art patents describe in symmetrical combination opposing pairs of shallow holding elements with different but cooperating-features to open and stabilize a shallow incisional site. None of the prior art patents other than Alvarez-Jacinto teach in combination a retractor applicable for shallow hernia surgery of approximately 3/4" to several inches deep, requiring both a shallow support and stable tissue separation.
For example, while the McCrory and Person retractor utilizes finger hooks, the finger hooks extend from a non-adjustable elliptical frame having a pair of opposing convex ends, adjacent to a pair of concave sides to f it the contour of the abdomen. The drawback to the McCrory and Person device in shallow surgeries is that the "window" of the open surgical site cannot be quickly closed, as is necessary in shallow surgeries where overlaying tissues and musculatures are incrementally sutured in stages. Moreover, while the Mahorner thyroidectomy retractor includes two opposing sets of prongs, the prongs are located upon the apex of two generally upside down U-shaped bars, to drape over and fit the convex configuration of the neck being incised. The Mahorner device does not have rounded blades to assist in anchoring the device, by retracting fatty tissues at the corners of a shallow surgical site, such as a hernia surgery site.
Other retractor instruments are described in U.S. Pat. Nos. 4,412,532 of Anthony, 3,776,240 of Woodson, 3,749,088 of Kohlmann, 4,257,406 of Schenk, 4,337,763 of Petrassevich, 4,784,150 of Voorhies, 4,887,756 of Puchy, 4,610,243 of Ray, and 4,834,067 of Block.
Many of the aforementioned patents are for retractors for deeper surgery, where the holding elements can grab onto deeper tissues and elements, or have complicated holding mechanisms for shallow surgeries, such as eye surgery.
The bladder type scoop-like retractor blades of Gauthier hold skin flaps apart, but do not anchor in place in the same manner as the present invention. The present invention uses rounded bladder type scoop-like blades to hold back movable corner fatty tissues, which must be held back from retreating back towards the surgical site. If so, intruding fatty tissues can obstruct the vision of the surgeon.
Moreover, the prior patents do not describe a retractor which in combination both holds back fatty tissue while stabilizing the retractor within a shallow surgical site, to keep the retractor from slipping and therefore loosening or springing out of its site during surgery.
In addition, the use of the bladder type scoop blades in the present invention isolates the site from migrating fatty tissues, which are much more mobile than deeper internal organs in deeper non-hernia type surgeries, while the retractor is held in place by opposing pluralities of pointed tip hooks engaging the incised tissues.
Furthermore, the prior art patents do not describe a retractor which facilitates the unique suturing of a hernia surgery, which is generally done by repeated suturing of overlapping layers of tissue like flaps of a double-breasted suit, wherein the skin and tissue flaps keep getting smaller until the surgical site is closed.
For example, in shallow hernia surgeries, it is necessary to constantly and incrementally open and close the opening of the visual "window" of the retractor frame in width with adjustment type fasteners until the outer stitching is complete. A typical example of this type of surgery or technique is noted in the medical references as a "should ice Canadian hernia surgery." With the present invention, post incisional stitching is accomplished by incremental reduction in size of the open "window" of the frame, wherein the parallel main bars with the pointed tip hooks may be moved closer together by slidably moving one of the main bars with the pointed tip hooks along the axis of the parallel strut bars toward the other main bar. The gradual closing of the wound is accomplished by the aforementioned techniques, which require a tension-free wound to prevent surgical sutures from ripping or breaking from the wound site.
Optionally the pointed tip hooks may be permanently affixed to the main bars of the present invention, or the pointed tip hooks may be formed integrally with extension members having slots extending axially therein, to permit the adjustable placement of the pointed tip hooks with respect to each other when inserted within the body being incised.